Community Mortality from Cholera: Urban and Rural Districts in Zimbabwe

Morof, Diane; Cookson, Susan T.; Laver, S; Chirundu, Daniel; Desai, Sarika; Mathenge, Penninah; Shambare, Donald; Charimari, Lincoln; Midzi, Stanley; Blanton, Curtis; Handzel, Thomas

doi:10.4269/ajtmh.11-0696

Cited by 24 publications

(27 citation statements)

References 13 publications

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“…This decline or plateau was associated with decreased funding for diarrhea control projects, declining commercialization of ORS, and inconsistent messaging regarding homemade ORS ( 16 ). In addition, >30% of cholera decedents delayed seeking care by >6 h. Although other cholera mortality studies have not directly addressed the effect of delays in seeking care, several studies have identified distance to health facilities or lack of transportation as barriers to timely care in rural populations ( 14 , 17 , 18 ). In this urban epidemic, all decedents were able to reach a health facility within 1 hour.…”

Section: Discussionmentioning

confidence: 99%

Cholera Mortality during Urban Epidemic, Dar es Salaam, Tanzania, August 16, 2015–January 16, 20161

McCrickard¹,

Massay²,

Narra³

et al. 2017

Emerg. Infect. Dis.

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In 2015, a cholera epidemic occurred in Tanzania; most cases and deaths occurred in Dar es Salaam early in the outbreak. We evaluated cholera mortality through passive surveillance, burial permits, and interviews conducted with decedents’ caretakers. Active case finding identified 101 suspected cholera deaths. Routine surveillance had captured only 48 (48%) of all cholera deaths, and burial permit assessments captured the remainder. We interviewed caregivers of 56 decedents to assess cholera management behaviors. Of 51 decedents receiving home care, 5 (10%) used oral rehydration solution after becoming ill. Caregivers reported that 51 (93%) of 55 decedents with known time of death sought care before death; 16 (29%) of 55 delayed seeking care for >6 h. Of the 33 (59%) community decedents, 20 (61%) were said to have been discharged from a health facility before death. Appropriate and early management of cholera cases can reduce the number of cholera deaths.

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Section: Discussionmentioning

confidence: 99%

Cholera Mortality during Urban Epidemic, Dar es Salaam, Tanzania, August 16, 2015–January 16, 20161

McCrickard¹,

Massay²,

Narra³

et al. 2017

Emerg. Infect. Dis.

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“…This hypothesis seems to be confirmed by a study done in Zimbabwe, using the same methodology as ours, where people with cholera who died were 17.2 times more likely to have received care at home. 12 Another study from Rwanda showed an association between patients' death and case management in the TCTC. 13 Our study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Fatal Outcomes Following Cholera-Like Syndrome in Far North Region of Cameroon: A Community-Based Survey

Djouma¹,

Ateudjieu

Ram

et al. 2016

The American Society of Tropical Medicine and Hygiene

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This study demonstrates that most cholera deaths in this region of Cameroon occur out of hospital. This is a region which is prone to cholera, and interventions are needed to improve access to emergency medical care, especially during cholera outbreaks. Cameroon has experienced 14 cholera epidemics during the last 20 years, and these have had high case fatality rates. This study attempted to assess the effect of delays in seeking care and the locations of care as possible risk factors for cholera mortality. The study used data from a community-based survey regarding the circumstances of 97 fatal cases and 197 control (nonfatal) cases following a cholera-like syndrome in villages with cholera-like diseases during cholera outbreaks in Cameroon during 2009-2011. Deaths occurred in one of four environments: the community, in a temporary community treatment center (TCTC), in transit to a treatment center, or in a hospital (39%, 32%, 5%, and 24%, respectively). Using a case-control analysis, factors associated with deaths included the nonuse of a cholera treatment center, receiving health care in a TCTC instead of a hospital, and greater than 4 hours delay between the onset of symptoms and the decision to go to a treatment center (odds ratios of 17.1 [confidence interval (CI): 7.0-41.8], 2.5 [CI: 1.2-5.0], and 2.2 [CI: 1.0-4.6], respectively). During cholera epidemics, a higher proportion of deaths are still occurring in communities. The nonuse and delays in deciding to go a treatment center, and treatment at TCTC rather than a hospital were risk factors for death among patients with cholera-like syndrome in Cameroon. Informing people on community management of cholera-like syndrome and improving care in all health facilities are needed to reduce deaths during cholera epidemics.

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“…By the time the 2008/2009 cholera outbreak struck, the health system was at its weakest. It was characterized by a critical shortage of skilled as well as motivated health workers; critical shortages of essential medicines and supplies and medical technologies; dilapidated health infrastructure; unreliable health information systems and weak surveillance systems; poor service delivery and poor health stewardship under inexperienced health leadership [20]. In one study on community mortality from Cholera in Zimbabwe, the poor access to health services and limited availability of oral rehydration salts were some of the causes for high community mortality [20].…”

Section: Response To Cholera Outbreaks Overtimementioning

confidence: 99%

“…Apart from the human resources, the resources required to implement a rapid response where not available at the initial stages of the outbreak because of economic challenges. The harsh economic climate characterized by hyperinflation meant that the common people did not have sufficient funds to get them to the health facility as well as procure the sugar and salt for preparing the oral rehydration solution [20].…”

Section: Magnitude Of the 2008/2009 Outbreak And Response Effortsmentioning

confidence: 99%

“…The 2008/2009 cholera outbreak in the country drew a lot of interest from the local and international scenes including journalists, scientists and human rights activists [17][18][19][20][21][22]. From the documentation on the various themes pertaining to this outbreak the country remains with a wealth of information to learn from and avoid similar situations from happening in the future.…”

Section: Building Resiliencementioning

confidence: 99%

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Responding to Cholera Outbreaks in Zimbabwe: Building Resilience over Time

Chimusoro¹,

Maphosa²,

Manangazira³

et al. 2018

Current Issues in Global Health

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Cholera is still a major cause of disease epidemics in sub-Saharan Africa (SSA). During the period January 2017-March 2018, 15 countries in the WHO African Region (AFR) reported cholera outbreaks of varying magnitudes. Zimbabwe has experienced cholera outbreaks dating as far back as 1971 with an unprecedented outbreak occurring in 2008/2009 when 60 of the 62 districts in the country were affected. The outbreak was declared over in May 2009 and by then, 98,592 cases and 4288 deaths had been reported. In Zimbabwe, outbreaks have occurred against a backdrop of a struggling economy and a weak health system. The role of a resilient health system in emergencies response is accentuated premised on experiences from the Ebola outbreak that largely affected three countries in West Africa. Amidst economic and persistent system wide challenges faced by Zimbabwe, preparedness and response capacity has been built over the years. This is evidenced by the rapid response and containment of the recent cholera outbreak. Skilled and equipped rapid response teams, strengthened surveillance and maintaining high alert, effective multisectoral collaboration and high level political engagement are among the critical elements that have built resilience.

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Community Mortality from Cholera: Urban and Rural Districts in Zimbabwe

Cited by 24 publications

References 13 publications

Cholera Mortality during Urban Epidemic, Dar es Salaam, Tanzania, August 16, 2015–January 16, 20161

Cholera Mortality during Urban Epidemic, Dar es Salaam, Tanzania, August 16, 2015–January 16, 20161

Factors Associated with Fatal Outcomes Following Cholera-Like Syndrome in Far North Region of Cameroon: A Community-Based Survey

Responding to Cholera Outbreaks in Zimbabwe: Building Resilience over Time

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